Overview

Cesarean section is surgical delivery through an abdominal and uterine incision. Planned (scheduled) cesareans allow preoperative teaching and spinal/epidural anesthesia; emergent cases may require general anesthesia with a decision-to-incision goal under 30 minutes. The post-cesarean client needs simultaneous surgical and postpartum monitoring — atony, hemorrhage, and lochia remain risks regardless of delivery route.

Indications

cephalopelvic disproportion

transverse lie

malpresentation

breech presentation

malpresentation

complete placenta previa

absolute cesarean indication; no vaginal exam

prior classical uterine incision

failed induction

non-reassuring fetal status

unresponsive to intrauterine resuscitation

Incision Types

Skin incision direction does NOT reveal the uterine incision — a vertical skin cut can still overlie a low-transverse uterine incision. The uterine incision type, read from the operative report, determines all future delivery planning.

Uterine incision implications

Low-transverseClassical (vertical)

FrequencyMost commonLess common

Rupture riskLowest4-9%

Future deliveryMay allow TOLAC/VBACRepeat cesarean for all

Low-transverse

Frequency: Most common
Rupture risk: Lowest
Future delivery: May allow TOLAC/VBAC

Classical (vertical)

Frequency: Less common
Rupture risk: 4-9%
Future delivery: Repeat cesarean for all

Before the Procedure

Scheduled cesarean pre-op sequence

Verify consentlegal first step
Oral antacidsodium citrate, lead time
Apply SCDswhile positioning is easy
Insert Foleybladder decompression
Skin preplast, before draping

During — Monitoring

left lateral tilt positioning

displaces gravid uterus off vena cava; prevents aortocaval compression

decision-to-incision under 30 minutes

emergent cesarean benchmark

spinal or epidural anesthesia

preferred for planned cesarean

After — Complications

fundal firmness assessment Hallmark

gently, supporting the incision; detects atony

lochia monitoring

amount, color, clots

incision inspection

redness, drainage, approximation

bowel sounds and flatus

return of bowel function; ileus risk

intake and output

until Foley removed, typically 12-24 hours

incentive spirometry

prevents atelectasis

early ambulation 8-12 hours

reduces DVT and ileus risk

Patient Teaching

splint incision when moving

early breastfeeding encouraged

as soon as mother and infant stable; not delayed for diet or ambulation

uterine incision type guides future deliveries

Report Nowescalate immediately

boggy fundus Hallmark

uterine atony — postpartum hemorrhage

excessive or bright-red lochia

saturating pad, large clots

incisional redness or purulent drainage

surgical site infection

wound dehiscence

absent bowel sounds with abdominal distension

paralytic ileus

unilateral calf warmth and tenderness

DVT

dyspnea or pleuritic chest pain

pulmonary embolism

Clinical Pearl

Skin scar does not equal uterine scar — always read the operative report for the uterine incision type, because it dictates every future delivery plan.

Cesarean Section